Intravitreal Injection Is Associated with Increased Posterior Capsule Rupture Risk during Cataract Surgery: A Meta-Analysis

Abstract

Background: Although observational studies have suggested that prior intravitreal therapy may predict posterior capsule rupture (PCR) during cataract surgery, this finding is still controversial. Objective: This study aimed to summarize current evidence on the association between prior intravitreal injection (IVI) and PCR during cataract surgery. Methods: A systematic literature search was performed up to October 27, 2021. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. The potential association between IVI and PCR in future cataract surgeries was assessed using the following two models: "pooling the ORs of PCR in eyes with and without previous IVI(s)"and "pooling the ORs for PCR relative to each increase in the number of prior injections."The quality of included studies was appraised using the Newcastle-Ottawa Scale. Results: Six cohort studies were included in this meta-analysis, with a total of 1,051,097 eyes that underwent cataract surgery. Of these, 7,034 eyes were associated with previous IVI. The pooled odds of PCR in eyes with prior IVI was 2.01 (95% CI: 1.35-3.00) times higher than that of eyes without an IVI history. An increase in the number of previous IVI conferred increased odds of PCR of 1.03 (95% CI: 1.01-1.06). After excluding studies that failed to account for confounders, the significantly increased risk was not altered, and the significant heterogeneity was minimized in both models. Conclusion: This meta-analysis provides evidence that previous IVI significantly increases the risk of PCR during future cataract surgery. The risk of PCR should be discussed preoperatively with patients. Further studies are required to validate our findings and explore the underlying mechanisms.